New Approaches in the Management of Rectal Carcinoma Result in Reduced Local Recurrence Rate and Improved Survival

Vironen, Jaana; Halme, Leena; Sainio, Peter; Kyllönen, L.; Scheinin, Tom; Husa, A; Kellokumpu, Ilmo

doi:10.1080/110241502320127775

Cited by 23 publications

(17 citation statements)

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“…Case volume has been suggested as an indicator of surgical quality of individual surgeons [10, 15]. This was not however a significant determinant in this study.…”

Section: Discussioncontrasting

confidence: 33%

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Treatment of Rectal Cancer: Reduction of Local Recurrence after the Introduction of TME – Experience from One University Hospital

et al. 2006

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Background: Local recurrence (LR) of cancer after rectal surgery is followed by significant morbidity and mortality. Since the introduction of total mesorectal excision (TME) the rates of LR have decreased in many centres. The aim of this retrospective study was to investigate the effect of TME on the recurrence rates of rectal cancer and the impact of the surgeons. Methods: All patients resected for invasive rectal cancer from 1990 until 2000 were initially included in the study. From February 1994, TME was adopted as the standard treatment (TME group). Before this period, rectal surgery was performed by the non-TME technique (non-TME group). To obtain homogeneity, patients who underwent preoperative irradiation, emergency operations, pre- or intraoperative bowel perforation, residual tumour stage (R1,2) including Dukes’ D stage and postoperative mortality within 31 days, were excluded. 139 patients in the non-TME group and 181 patients in the TME group were found eligible for analyses. Results: The estimated LR rate at 1, 3 and 5 years was 7, 15 and 17% (non-TME) versus 4, 9 and 9% (TME) (p = 0.046, log-rank test). The anastomotic leakage rate was 6% (non-TME) versus 4% (TME) (not significant). Perioperative blood loss >500 ml, reoperations during the hospital stay and lymph node (N) stage were the independent risk factors for LR in the multivariate analysis. The case volume did not significantly influence LR rates. However, the variability of individual surgical results was reduced after the introduction of TME. Conclusions: TME yields significantly lower LR rates compared with traditional surgery. Since the introduction of TME, experience with rectal surgery has been gathered by a limited number of surgeons. The results of individual surgeons have consistently improved and the variability of individual surgical results is now at a lower level.

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“…Case volume has been suggested as an indicator of surgical quality of individual surgeons [10, 15]. This was not however a significant determinant in this study.…”

Section: Discussioncontrasting

confidence: 33%

“…A recently published report from Finland showed a reduction of LR rate from 17 to 9% and survival rates were improving after the introduction of the TME technique [15]. Recent publications from Norway have also shown that standardization of the surgical technique with TME may cause improvement in results [1, 16, 17].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Rectal Cancer: Reduction of Local Recurrence after the Introduction of TME – Experience from One University Hospital

et al. 2006

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“…A dramatic impact of the TME technique on local recurrence rate was observed in our series, comparing the currently achieved recurrence rate of 6.1 % after AR and 11.7 % after APE with respective rates of 17-22 and 36 %, before the TME era in the same unit [19,20]. In line with previous studies, the risk of local recurrence after transanal local excision and APE was higher than after AR and in low rectal cancer in general [4,5,18].…”

Section: Discussionmentioning

confidence: 89%

Pattern of rectal cancer recurrence after curative surgery

Räsänen

Carpelan-Holmström

Mustonen

et al. 2015

Int J Colorectal Dis

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“…Vergleicht man diese Ergebnisse mit den Resultaten aus der Ära vor der TME, so zeigt sich eindrücklich, dass die Lokalrezidivrate durch die TME signifikant gesenkt werden konnte: So erniedrigte sich bei Dahlberg et al die Lokalrezidivrate von 14% (1985-1989, ohne TME) auf 5% (1990-1995, mit TME), Arbman et al berichten, dass die Lokalrezidivrate von 14,2% (1984-1986, ohne TME) auf 6,3% (1990-1992, mit TME) gesenkt werden konnte [3,14]. Beide Studien aus Schweden stehen hierbei exemplarisch für zahlreiche Zentren, die über identische Daten berichten [11,40,41,42,43,44,95,98,100].…”

Section: Ergebnisse Der Tme Im Literaturvergleichunclassified

Chirurgische Therapie des Rektumkarzinoms

et al. 2003

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Total mesorectal excision (TME) has gained a revolutionary impact on the surgical therapy of rectal cancer within the last 2 decades, providing superior local tumor control in comparison to conventional resection. Consequently, 85% of rectal carcinomas can be resected by sphincter-preserving surgery without compromising either oncologic radicality or continence. With the introduction of TME, local recurrence rates have been reliably decreased below 10% after curative resection. Surgical dissection along the connective tissue space between rectal and parietal pelvic fascia with complete mesorectal excision results in reliable excision of all relevant lymphatic pathways with preservation of continence and sexual function. Complete removal of a TME specimen is mandatory in carcinomas of the middle and lower third of the rectum. Both removal of the complete TME specimen and careful pathologic examination of the circumferential resection margin have decisive significance. An additional pelvic lymphadenectomy with the potential risk of increased morbidity does not improve prognosis. As a spread of tumor distally along the bowel wall rarely exceeds a few centimeters, a distal resection margin of 1-2 cm is oncologically sufficient in sphincter-saving procedures without compromising prognosis. Taken together, the convincing results of TME provide a rationale for using TME as the dissection policy of choice to resect rectal cancers in the distal two-thirds of the rectum, despite the absence of direct evidence from prospective randomized trials. The question whether laparoscopic curative resection for rectal cancer is oncologically adequate cannot be definitely answered to date, as results of randomized studies are currently missing. However, the preliminary results of laparoscopic resection for rectal cancer provided by centers are promising.

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New Approaches in the Management of Rectal Carcinoma Result in Reduced Local Recurrence Rate and Improved Survival

Abstract: Despite an increased number of anastomotic complications TME is safe. Refinement of the surgical technique together with preoperative radiotherapy yields lower local recurrence rates and an improved survival compared with conventional surgery alone.

Cited by 23 publications

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Treatment of Rectal Cancer: Reduction of Local Recurrence after the Introduction of TME – Experience from One University Hospital

Treatment of Rectal Cancer: Reduction of Local Recurrence after the Introduction of TME – Experience from One University Hospital

Pattern of rectal cancer recurrence after curative surgery

Chirurgische Therapie des Rektumkarzinoms

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